Vol.:(0123456789) 1 3 The International Journal of Cardiovascular Imaging https://doi.org/10.1007/s10554-018-1392-3 ORIGINAL PAPER Diagnostic accuracy of multi-slice computed tomography in identifying lesion characteristics in coronary total occlusion Islam Abdelmoneim 1  · Ayman Sadek 1  · Mohamed Ahmed Mosaad 1  · Ibrahim Yassin 1  · Yasser Radwan 1  · Khalid Shokry 2  · Ahmed Magdy 2  · Mohammed Yasser Elsherbeny 3  · Abdelrahman Ibrahim Abushouk 4 Received: 6 May 2018 / Accepted: 4 June 2018 © Springer Nature B.V. 2018 Abstract We performed this study to compare the sensitivity and specifcity of multi-slice computed tomography (MSCT) to coronary angiography (CA) in detecting coronary total occlusion (CTO) lesion characteristics. Moreover, we analyzed the association between these characteristics and the risk of revascularization failure. Fifty patients with confrmed CTO diagnosis were tried for revascularization using the antegrade (all 50) or retrograde (in failed nine antegrade interventions) approaches. Each patient underwent CA and MSCT before the intervention and data from both modalities were compared using the SPSS software. Successful revascularization occurred in 36 (72%) and 6 (66.7%) patients of the antegrade and retrograde groups, respectively. Compared to CA, MSCT exhibited high sensitivity in detecting CTO segment calcifcation (100%), size of the afected vessel (100%, area under the curve [AUC] = 0.82), distal flling of the afected segment (97.7%) and side-branching at the CTO segment (93.3%). However, it had lower sensitivity in detecting collaterals (75%) and the length of the afected segment (87.5%, AUC = 0.77). According to MSCT data, increased occlusion length > 18 mm (p = 0.01), atherosclerotic vessel wall (p = 0.02), small distal vessel size ≤ 2.75 mm (p = 0.002), proximal side-branching (p = 0.01) and calcifcation of the proximal cap (p = 0.007) or distal stump (p = 0.01) were associated with an increased risk of revascularization failure. MSCT exhibited high sensitivity in identifying several CTO lesion characteristics, such as lesional calcifcation and size of the afected vessel. However, further research is needed to improve the diagnostic accuracy of this modality and defne the predictors of revascularization failure in CTO patients. Keywords Computed tomography · Coronary angiography · Coronary occlusion · Percutaneous coronary intervention Abbreviations CA Coronary (conventional) angiography CTA Computed tomography angiography CTO Chronic total occlusion MSCT Multi-slice computed tomography PCI Percutaneous coronary intervention Introduction Chronic total occlusion (CTO) in the coronary circula- tion indicates complete blockage of a coronary artery for 30 days or more [1]. Among patients with diferent clinical profles who had coronary angiography (CA), CTO preva- lence ranges between 18 and 52% [2]. Recent meta-analyses reported that successful CTO revascularization was associ- ated with a signifcant reduction in the risk of mortality, sub- sequent coronary artery bypass grafting (CABG) and recur- rent angina [3, 4]. In the past, CTO patients required CABG; however, as a result of advanced technology, percutaneous coronary intervention (PCI) showed favorable outcomes in clearing the coronary blockage with success rates between 55 and 85% [5, 6]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10554-018-1392-3) contains supplementary material, which is available to authorized users. * Abdelrahman Ibrahim Abushouk Abdelrahman.abushouk@med.asu.edu.eg 1 Cardiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt 2 Specialized Heart Center, Kobri El-Kobba Military Hospital, Cairo, Egypt 3 Faculty of Medicine, Mansoura University, Cairo, Egypt 4 Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt